32. Hygienic phase Flashcards
Treatment sequence is according to
Ramfjord
Aim of hygienic phase
- Achieve infection free oral cavity, free of plaque and calculus
- Removal of plaque retentive factors
- Extraction of irrational to treat teeth
- Scaling and planning
Natural plaque retentive factors
- Calculus
- Deep fissures and equators
- Caries
- Crowding
- Furcations
- Malocclusion-crowding, rotations
- Frenuli
- Recession
- Shallow vestibulum
Types of frenulum
- Gingival
- Mucosal
- Papilla
- Papilla penetrating
Iatrogenic plaque retentive factors
- Poorly adapted restorations
- Fixed orthodontic appliances
- Mouth breathing-xerostomia/hyposalivation
Types of prognosis
- Good
- Doubtful
- Irrational to treat
Factors used in different types of prognosis
- Periodontal
- Endodontic
- Dental
- Functional
Periodontal doubtful prognosis
- Furcation involvement=1 or 2
- Angular bony defects
- Horizontal bone defect reaching 2/3 of root
Periodontal irrational prognosis
- Recurrent abcess
- Combined endo and periodonal lesion
- Attachment loss to apex
- Furcation involvement= 3
Endodontic doubtful prognosis
- Large post or screw obturations
- Incomplete root canal
- Peri-apical pathology
Endodontic irrational to treat prognosis
Perforations in apical half of root
Dental doubtful prognosis
- Extensive root caries that does not extend into root canal
Dental irrational to treat prognosis
- Extensive root caries that does extend into the root canal
- Verical root fractures 2/3 of the root
- Oblique fractures into middle third of tooth
Functional irrational to treat prognosis
- Third molars only without antagonist
- Grade 3 mobility
- Periodontitis and caries
When re-evaluation done
6 week to 6 months
What is done during re-evaluation
- Periodontal risk assessment
- Full periodontal status
Information contained in periodontal risk assessment
- Age
- Number of implants
- Number of sites per tooth/implant
- No. of bop positive sites
- No. of sites w/ pocket depths >5mm
- No. of missing teeth
- % alveolar bone loss
- Systemic genetic diseases
- Smoking(environmental factors)
Environmental factors include
- Non smoker
- Former smoker
- Occasional smoker
- Smoker
- Heavy smoker
When epithelium regenerates
10-14 days
When connective tissue regenerates
6 weeks
When bone reforms
6 weeks to 3 months
When periodontal healing takes place
up to 6 months
Motivation Interview
- Open ended questions
- Affirm patient
- Empathise
- Provide info in neutral way(research indicates/ my patients tell me that)
-What are your thoughts
-You are clearly
